Abstract W P5: Improvements in Procedural Times in the Evolution of Endovascular Treatment of Acute Ischemic Stroke
Purpose: Endovascular therapies are increasingly used in the revascularization of acute ischemic stroke from large vessel occlusions. There have been many design improvement of these devices from their initial implementation to the recent newer generations of devices. The goal of this case review study was to assess if there was corresponding improvement in procedural times over the course of the evolution of these devices.
Methods: We pooled prospective (Pivotal, PICS, START) and retrospective/registry (POST, RetroSTART, Speed 054) Penumbra trials. All obtained treatment at <8 hours. Data was collected and analyzed. Tested covariates (patient demographics, procedure time points) were considered in the multivariable model.
Results: Among 1028 pooled subjects, 93 received treatment outside the 8 hour window, and an additional 8 subjects were excluded due to missing key data. The remaining 927 patients had a mean age of 65.9 years (SD=15.1) and 51.7% (478/925) were female. At admission, the average NIHSS was 17.4 (SD=6.2) and 100% of patients had a TIMI score of 0 or 1 (919/919).
Across the Penumbra trials, the time from PS on to off and overall procedure length have shown a significant decrease over time (p<0.0001, p=0.0001 ). From 2006 to 2011, the time from PS on to off decreased an average of 5 minutes per year. The reduction in time from PS on to off is also significantly associated with the increased catheter size (p=0.0001). Similarly, the average procedure time decreased significantly with the newer catheters from 99.9 minutes (SD=46.7) using the 026 catheter to 65.6 minutes (SD=36.3) using the 054 catheter (p<0.0001). Ultimately, shorter procedure time was a significant predictor of good outcome, measured by mRS score of 0 or 1 (p=0.021).
Conclusion: These results suggest that the implementation of the newer and larger Penumbra catheters provides a quicker and more effective treatment method for treating acute ischemic stroke.
Author Disclosures: D. Frei: Ownership Interest; Significant; Penumbra Inc. A. Patel: Speakers' Bureau; Modest; Penumbra, Inc., Codman. R. Gupta: Research Grant; Significant; Penumbra Inc.. R. Bellon: None. D. Huddle: None. G. Dooley: None. H. Buell: Employment; Significant; Penumbra Inc. K. Adamski: Employment; Significant; Penumbra Inc. S. Kuo: Employment; Significant; Penumbra Inc. A. Bose: Employment; Significant; Penumbra Inc.. Ownership Interest; Significant; Penumbra Inc. S. Sit: Employment; Significant; Penumbra Inc.. Ownership Interest; Significant; Penumbra Inc..
- © 2015 by American Heart Association, Inc.